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Ear - Clinical Medicine IV > Otitis > Flashcards

Otitis Flashcards

1
Q

Who gets acute otitis media?

A

children - due to horizontal Eustachian tube

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2
Q

Where is the fluid build up in acute otitis media?

A

behind tympanic membrane

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3
Q

What are the symptoms in acute otitis media?

A

pull on ear, painful, fever, hearing impairment (due to vibratory bones), fullness/ear pressure

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4
Q

How can you diagnosis acute otitis media?

A

otoscopic examination

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5
Q

What will you see with acute otitis media on otoscope exam?

A

bulging and lack of mobility with pneumotoscopy, possibly red

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6
Q

How do you treat acute otitis media?

A

amoxicillin - first line

or: TMP-SMX, cephalosporin or azithromycin

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7
Q

What do you for resistant acute otitis media?

A

augmentin - amoxicillin+clavulanate

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8
Q

What occurs usually before acute otitis media?

A

URI than blocks tube then fluid builds up then bacteria infects

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9
Q

What is otitis media?

A

middle ear infection

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10
Q

What are the most common pathogens in AOM?

A

s. pneumonia, H.flu, Group A strep, m. cat

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11
Q

What presentation of AOM is emergent?

A

frank swelling over mastoid bone or cranial neuropathies or central findings

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12
Q

What is the surgical drainage of the middle ear called?

A

myringotomy

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13
Q

What can develop from untreated otitis media?

A

mastoiditis, requires CT, tx myringotomy + IV ABX

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14
Q

What is chronic otitis media?

A

chronic otorrhea with perforated tympanic membrane

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15
Q

What bacteria cause chronic otitis media?

A

p. aeru, s. aureus, proteus, anaerobes

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16
Q

Is chronic otitis media painful?

A

usually not

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17
Q

How you diagnosis chronic otitis media?

A

look in ear - see drainage and rupture; hearing loss

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18
Q

How do you treat chronic otitis media?

A

remove debris, use earplugs, avoid water, topical ABX drops, ABX

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19
Q

What is the oral ABX used to treat chronic otitis media?

A

ciprofloxacin 500 mg bid 1-6 wks

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20
Q

What are the topical ABX drops?

A

ofoxacin, ciprofloxacin w/dexamethasone

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21
Q

What is a surgical tx for chronic otitis media?

A

tympanic membrane reconstruction with temporalis muscle fascia

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22
Q

What is otitis externa usually called?

A

swimmers ear

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23
Q

What is malignant external otitis ?

A

osteomylitis of skull base that requires hospitalization

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24
Q

Who gets malignant external otitis?

A

DM or Immunocompromised

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25
Q

What causes external otitis?

A

gram - (pseudo, proteus) or fungi (ASPERGILLUS)

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26
Q

What causes malignant external otitis?

A

usually pseudomonas aeru

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27
Q

What are the symptoms of external otitis?

A

ear pain (tragus), redness and swelling, purulent discharge,

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28
Q

How does malignant external otitis present?

A

focal aural discharge, granulations in ear, deep otalgia, cranial nerve palsy

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29
Q

How do you dx malignant external otitis?

A

osseous erosions on CT

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30
Q

How do you treat external otitis?

A

swimmers ear - isopropyl alcohol + white vinegar
Infected - neomycin sulfate, polymyxin B sulfate, hydrocortisone
Recalcitrant - oral fluroquinolone (cipro)

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31
Q

How do you treat malignant external otitis?

A

ciprofloxacin for months even if asymptomatic

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32
Q

What is cholesteatoma?

A

white debris in chronic OM, get head CT!

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33
Q

What is the most common form of OE?

A

acute diffuse, swimmers

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34
Q

What OE is associated with hair follicle?

A

acute localized OE (furunculosis)

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35
Q

What is the duration for chronic OE?

A

> 6 wks

36
Q

What OE encompasses various derm conditions that may infect the EAC?

A

eczematous (eczematoid) OE

37
Q

What is OE that extends into the deeper tissues adjacent to EAC?

A

Necrotizing (malignant) OE

38
Q

Who gets malignant OE?

A

immunocompromised - DM, HIV

39
Q

What are the symptoms of acute infective OE?

A

otorrhea (foul), pruritis, hearing loss, pressure or fullness, swelling of ear canal

40
Q

What is the most common causative agent in acute infective OE?

A

pseudomonas!!!

staphylococcus, anaerobes, gram -

41
Q

What is the guidelines for OE dx and treatment?

A
  1. rule out other causes
  2. assess factors that could modify management
  3. assess for pain
42
Q

What type of ABX do you get for OE?

A

TOPICAL

43
Q

What can cause acute OE?

A

obstruction, lack of cerumen, trauma, alteration of pH by removing wax

44
Q

What happens once infection is established in OE?

A

skin edema, exudate and drainage

45
Q

What are the treatment of otitis externa?

A

pain management, remove debris, administer topical meds. avoid contributing factors

46
Q

What are the topical ABX used for OE?

A

ABX + sertoid combo
avoid alcohol
Ciprodex or Ofloxacin, 4 gtt in affected ear BID x 5-7 days

47
Q

What do you do in OE if canal is swollen?

A

otowick -> keps ear dry

48
Q

What are the bacterial OE treatment options?

A

ciprofloxacin
Cirpo+hydrocoritsone - cipro HC
Cipro/dexameth - ciprodex
Neomycin/polymyxin B/hydrocortison - cortisporin
Ofloxacin
Hydrocortisone/acetic acid - bacterial or fungal

49
Q

What is the clinical manifestation of malignant OE?

A

persistent otalgia >1 mo, purulent otorrhea, granulation tissue or exposed bone in ear canal, CN involvement VII, X, XI

50
Q

What is the treatment for malignant OE?

A

inpatient admission, CT scan temporal bone, culture ear, IV ABX, surgical debridement

51
Q

What are the IV ABX for malignant OE?

A

ciprofloxacin, aminoglycosides, 3rd generation cephalosporin, imipenem, ticarcillin/clavulante

52
Q

What is great about ciprodex and ofloxacin?

A

safe to give if TM rupture

53
Q

What are some of the causes of eczematous OE?

A

atopic dermatitis, psoriasis, SLE. eczema

54
Q

How do ezcematous OE present?

A

super itchy ear

55
Q

What would you see in ezcematous OE ear canal?

A

skin sheets, keratin debris

56
Q

How do you treat ezcematous OE?

A

steroid - fluocinolone optic (dermotic) oil apply 5 gtt in ear BID x 7-14 days, may need chronic tx

57
Q

What is herpes zoster oticus?

A

ramsy hunt - shingles of the ear

58
Q

How does the pt with herpes zoster oticus present?

A

burning pain, eruption of vesivular rash, not always visible, hearing loss, facial nerve paresis

59
Q

What is the treatment for HZO?

A

Acyclovir 800mg PO 5 times per day for 7 days
Famciclovir 500mg PO 3 times per day for 7 days
Valcyclovir 1000mg PO 3 times per day for 7 days
Steroids - prednisone or medrol dose pack

60
Q

What is acute suppurative OM?

A

inflammation of middle ear and TM, infective cause

61
Q

What is serous non-suppurative OM?

A

residual effusion post infection or related to ETD

62
Q

What is the time line for non-suppurative OM?

A

acute 3 mo

63
Q

What is the chronic types of OM?

A

infection in middle ear w/ TM perforation

w or w/o cholesteatoma

64
Q

What is the dx of serous OM?

A

air fluid levels behind TM, type B tympanometry, conductive hearing loss

65
Q

What is the treatment for serous otitis media?

A 
systemic ABX - Amoxicillin
Decongestants
Oral steroid - prednisone
antihistamines
myringotomy
66
Q

What is the presentation of acute OM?

A

after URI, otalgia w/ systemic symptoms

Fever, N/V/D

67
Q

Who is acute OM common in?

A

3 mo to 3 yrs

68
Q

What causes acute OM in newborns?

A

s. pneumo, H. flu, Gram - enteric bacilli (e coli, klebsiella, pseudomonas)

69
Q

What causes older infant and children

A

strep pneumo, m. cat, h. flu, less common group A strep and s. aureus

70
Q

What causes pt > 14 yo to get acute OM?

A

s pneumo, s. aureus, group A

71
Q

How do you dx acute OM?

A

TM bulging and ear pain for less than 48 hr, intense erythema,

72
Q

When should AOM not be dx?

A

pneumatic otoscopy and tympanometry do not show middle ear effusion

73
Q

Who gets ab for AOM?

A

severe signs = temp >39 C rectally within 24 hr, moderate to severe otalgia present for >48 hr

74
Q

What age always gets ABX for AOM?

A
75
Q

What do you need if 6mo-2 yr for ABX for AOM?

A

observe only for 48-72 if not severe

tx if bilateral OM

76
Q

What do you do for >2 yr with AOM?

A

ABX if severe, observe for 72 hr if not

77
Q

What are the disqualifiers for using amoxicillin in kids with AOM?

A

had it within 30 days, has concurrent conjunctivitis, allergic to penicillin
if cant then take
Amoxicillin-clavulante, cefuroxime, azithromycin, TMP-SMZ

78
Q

What can cause chronic OM?

A

AOM, ETD, mechanical trauma, thermal or chemical burns, blast injuries, iatrogenic cause

79
Q

What is chronic OM associated with increased risk?

A

craniofacial abnormalities, down syndrome, cri du chat syndrome, cleft lip, choanal atresia, microcephaly

80
Q

What are complications from COM?

A

aural polyps, cholesteatoma, other infections

81
Q

What are the most common causative agents of COM?

A

p aeru, proteus, s. aureus, mixed anarobes

82
Q

How do you dx COM?

A

culture drainage, CT or MRI for intratemporal or intracranial process

83
Q

What is a type of COM thats super serious?

A

cholesteatoma

84
Q

What is cholesteatoma releated to?

A

prolonged ETD and retraction of TM

85
Q

What is treatment for cholesteatoma?

A

surgical removal

86
Q

What is the treatment for COM?

A

keep ear dry, clean ear, topical steroids and ABX, systemic ABX, surgery

87
Q

What are the surgeries for COM?

A

tympanoplasty - marginal or attic perforations

Ear - Clinical Medicine IV (15 decks)

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